Name: Summit Academy OIC
Address: AF
Rating: 5

Summit Academy OIC takes student complaints of discrimination, harassment, unethical or unfair conduct as serious matters. So that we may properly investigate your concern, please fill out this form as completely as possible. Use additional sheets of paper where needed. After a prompt and thorough investigation into your complaint, you will receive follow-up regarding the outcome and any actions taken.

Name*

First Last

Program*

Date*

1. Please describe in as much detail as possible the nature of your complaint. Identify all known persons and witnesses to your concerns, as well as provide copies of any documents to MWilliams@saoic.org:

2. Please describe how the actions in your complaint affected your school experience:

3. Have you taken any steps yourself to resolve the situation? Did you speak with the student, instructor or staff person? Please indicate the steps that you have taken:

4. Describe any positive solutions you believe can help resolve your complaint:

5. Please provide any additional comments you wish Summit Academy OIC to consider when investigating your complaint:

I declare that the information provided on this form is true and accurate.*

Yes, I agree.

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